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Systematic review and meta‐analysis: Efficacy of patented probiotic, VSL #3, in irritable bowel syndrome
Author(s) -
Connell M.,
Shin A.,
JamesStevenson T.,
Xu H.,
Imperiale T. F.,
Herron J.
Publication year - 2018
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13427
Subject(s) - medicine , irritable bowel syndrome , bloating , meta analysis , placebo , randomized controlled trial , strictly standardized mean difference , medline , abdominal pain , physical therapy , alternative medicine , pathology , political science , law
Background VSL #3 is a patented probiotic for which several clinical trials suggest benefits on motor function, bloating, and symptoms of irritable bowel syndrome ( IBS ). Objectives To quantify effects of VSL #3 on abdominal pain, stool consistency, overall response, abdominal bloating, and quality of life ( QOL ) in IBS through meta‐analysis. Methods MEDLINE (Ovid SP and PubMed), EMBASE , Web of Science, and Scopus were searched up to May 2017. Using a fixed effects model, we pooled data from intention‐to‐treat analyses of randomized trials ( RCT s) comparing VSL #3 to placebo in IBS . Data were reported as relative risk ( RR ), overall mean difference ( MD ), or standardized MD ( SMD ) with 95% confidence intervals ( CI ). Quality of evidence was rated using the GRADE approach. Key Results Among 236 citations, 5 RCT s (243 patients) were included. No significant differences were observed for abdominal pain ( SMD = −0.03; 95% CI −0.29 to 0.22), bloating ( SMD = −0.15; 95% CI −0.40 to 0.11), proportion of bowel movements with normal consistency (overall MD = 0; 95% CI −0.09 to 0.08), or IBS ‐ QOL ( SMD = 0.08; 95% CI −0.22 to 0.39). VSL #3 was associated with a nearly statistically significant increase in overall response ( RR = 1.39; 95% CI 0.99‐1.98). Conclusions & Inferences In this systematic review and meta‐analysis, there was a trend toward improvement in overall response with VSL #3, but no clear evidence effectiveness for IBS . However, the number and sample sizes of the trials are small and the overall quality of evidence for 3 of the 5 outcomes was low. Larger trials evaluating validated endpoints in well‐defined IBS patients are warranted.